Benham-Hutchins, M. & Clancy ,T. R. (2010). Managing organizational complexity. social networks as embedded complex adaptive systems. The Journal of Nursing Administration, 40(9), 352. The authors of this article, both of whom are faculty at Texas Women's University School of Nursing, identify social network analysis (SNA) as a tool that is complementary to the theatrical underpinnings of complexity science. They assert that interprofessional communication is influenced not only by two individuals in communication with one another, but also by the social networks of which each is a part. The authors focus on the non-linear processes involved in communication between professionals and units when transferring a patient. Incorporating the theories of complexity sciences into research on communication networks could increase the applicability to healthcare organizations. Recognizing the complex nature and influence of social networks within an organization will assist the nurse leaders in our case study formulate solutions for the non-linear challenges they face.

The government is beginning the third year of fining hospitals for having too many readmissions of patients with Medicare, and penalties, as well as the categories of patients included in the data measured, are increasing. The goal is to encourage healthcare systems and care providers within them to manage chronic disease better. The problem is a complex one. Safety-net hospitals, which tend to have sicker patients with less resources, may not be able to meet the same bench marks that hospitals catering to the wealthy can. However, to set a lower goal for these hospitals would be tantamount to the government enforcing a lower standard of care for the poor. In addition, managing chronic disease to reduce readmission will reduce overall admissions, and some hospitals cannot remain financially stable if they do so. The article was produced for Kaiser Health News (KHN) in association with the Scan Foundation, whose stated mission is to promote aging with dignity and independence. It relates to another story published on KHS about a hospital system who has hired a nurse just to talk with people about their diabetes in an effort to promote patient self-care and knowledge, and reduce hospital admissions (McCammon, 2014). Reference McCammon, S. (2014). Personal attention seen as antidote to rising health costs. Georgia Public Radio & Kaiser Health News. Retrieved from http://kaiserhealthnews.org/news/care-coordinators-try-to-save-hospitals-money/

Griffin, D., & Hyrkas, K. (2014). The Development and Implementation of an Obstetrical Triage Tool to Prioritize Patients and Track Process Times by Risk Categories. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 43(Supp 1), S67.

Although this is an improvement in an OB triage area, I think the concept of coding patients based on acuity and developing a specialized triage nurse position can be useful in other specialties and ED settings.

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Advantages and disadvantages for patients in a multi-bed room, from the viewpoint of nurses and patients.

Persson, E. and Maata, S. (2012). To provide care and be cared for in a multiple-bed hospital room. Scandinavian Journal of Caring Sciences. 26 (4), 663-670. DOI: 10.1111/j.1471-6712.2012.00976.x

A retrospective study that finds the number of patients simultaneously present in an ED is a moderate predictor of unsafe waiting times. The authors conclude that it would be beneficial to look for other causes of unsafe waiting times, as well as devise system wide strategies for adaptation when the ED census is high.

Bergs, J., Verelst, S., Gillet, J., Deboutte, P., Vandoren, C., Vandijck, C. (2014). The number of patients simultaneously present at the emergency department as an indicator of unsafe waiting times: A receiver operated curve-based evaluation. International Emergency Nursing. 22(4): 185-189. DOI: 10.1016/j.ienj.2014.01.002